Activities Of Daily Living Instrumental Activities Of Daily Living Research Articles

Validity and reliability of the Persian version of Mini-Addenbrooke’s Cognitive Examination among Iranian highly educated older adults

Background Limited studies have examined psychometric properties of dementia screening tools in university-educated older adults. We aimed to examine this population’s diagnostic accuracy of the Iranian version of Mini-Addenbrooke’s Cognitive Examination (M-ACE). Materials & methods Eighty-seven participants with over 60 years with university education were divided into three groups: Major neurocognitive disorder, mild neurocognitive disorder, and healthy control. The Iranian version of M-ACE, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale and Diagnostic and Statistical Manual of Mental Disorders 5th edition-Text Revision (DSM-5) were used. Results A high internal reliability of questionnaire was confirmed by Cronbach’s alpha coefficient. One-way ANOVA and post hoc analysis confirmed a significant difference between study groups. The scores of M-ACE were found to have a high positive correlation with MMSE, IADL, ADL, and a moderate correlation with GDS. The optimal cutoff score of M-ACE to screen for mild and major neurocognitive disorders were 27.5 and 20.5, respectively. Conclusion The M-ACE was a concise and reliable tool used to identify neurocognitive disorders in highly educated older adults, but they should be evaluated at a higher traditional cut score in earlier stages.

Dementia prevalence among hospitalized older patients: a multicenter study in Iran.

To evaluate the prevalence of dementia and its associated risk factors among older patients admitted to hospitals. The study included older patients (≥ 60 years) admitted to medical departments of a general hospital in three major Iranian cities. Researchers utilized the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, the Geriatric Depression Scale (GDS), the Mini-Cog test, the 4 A's test (4AT), and the Abbreviated Mental Test Score (AMTS). Among the 420 recruited older inpatients, 228 (54.3%) were female. The mean age of participants was 71.39 years (standard deviation ±7.95), with 30.7% diagnosed with major neurocognitive disorder (dementia). The likelihood of dementia exhibited statistically significant correlations with gender, age, number of children, and occupation. Screening older individuals for cognitive impairment upon hospital admission holds the potential to prevent adverse outcomes and enhance the quality of treatment for patients concurrently dealing with dementia.

Evaluation of Functional Cognition in People Experiencing Homelessness: A Scoping Review

The identified prevalence of cognitive impairment in people experiencing homelessness has placed a focus on the use of measures of cognition to predict functioning and ability to move successfully into housing. Functional cognition is the cognitive ability to perform daily life tasks, incorporating cognitive functioning, performance skills, and patterns. Given the increased research on cognitive status and functional skills within people experiencing homelessness, a scoping review was conducted to synthesize the existing literature and identify how functional cognition is evaluated in this population, and identify implications for homeless and housing services. This scoping review was conducted using the Joanna Briggs Institute protocol. Included studies assessed functional cognition, or assessed a component of cognition and related it to functional performance. Of 8,848 articles retrieved from the initial search, thirty-seven articles were determined to meet the inclusion criteria for data extraction. Categories for data extraction included functional domain addressed, tools used for assessment of cognition and/or function, and how reported outcomes were interpreted. Narrative analysis identified domains of cognition and function assessed, and relationships between cognition and function domains. Only the functional domain of Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) were found to have a consistent relationship between cognition and performance and primarily when performance-based assessments were used. Challenges with generalizing study findings broadly include: study populations do not reflect demographics of those experiencing homelessness; a variety of assessment tools for cognition and function are utilized; and the broad use of the term function encompasses several different areas of independent living in the community. Several studies identified that even with the presence of decreased cognition, those with the experience of homelessness are able to maintain housing when given individualized and appropriate supports. This scoping review indicates inconsistent methods to assess cognition and functional cognition within people experiencing homelessness. Performance-based assessments of ADL/IADL are more likely to identify the impact of cognition on function, while neurocognitive assessments are more beneficial to assess social/community integration. Findings indicate that to support the transition from homelessness to housing and increase the likelihood of housing stability; assessments should focus on identifying strengths and necessary/individualized ongoing supports.

Abstract WP80: Stroke Outcomes Among English And Spanish Speaking Mexican Americans

Introduction: We examined if language preference was associated with differences in neurological, functional, and cognitive stroke outcomes among Mexican Americans (MAs). Methods: Ischemic or hemorrhagic stroke patients identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2009-2018). Poststroke outcomes at 90 days included neurological [National Institutes of Health Stroke Scale (NIHSS) range 0-44, higher worse], functional [activities of daily living/instrumental activities of daily living (ADL/iADL) range 1-4, higher worse], and cognitive [modified Mini-Mental State Examination (3MSE) range 0-100, lower worse]. Language was determined by which language participant preferred to complete outcome interview in. Differences in stroke outcomes by language were analyzed by weighted Tobit regression. Weights (baseline and outcome interview participation) were created by logistic regression to account for attrition. Age, education, initial NIHSS score, smoking status, BMI, insurance status, sex, and comorbidities were included in weighted Tobit regression models. Results: Of 1,096 patients, 1,001 preferred English and 95 Spanish. Spanish speakers were older (72 versus 66 years; p < 0.01), received less education (p < 0.01), and had higher prevalence of atrial fibrillation (p = 0.02) than English speakers. No other significant differences in baseline demographics or clinical factors were found. In fully adjusted models (Table 1) Spanish speakers had significantly better neurological and functional but worse cognitive outcomes compared with English speakers. Conclusion: This population-based study found better neurologic and functional stroke outcomes among Spanish speaking versus English speaking MAs. The difference in the cognitive outcome may be explained, at least in part, to lack of cultural equivalence of the test instrument. These data suggest further research into the resilience observed among Spanish speakers.

Functional status in older patients with cancer

BackgroundFunctional Status (FS) is an important domain in Comprehensive Geriatric Assessment (CGA) and is most often evaluated using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales separately. Method and objectivesThis secondary analysis of a previous prospective cohort study was conducted between September 2015 and May 2018 at Marseille University Hospital, France, on 613 cancer outpatients aged ≥70 years.The first objective of this study was to determine the prevalence of FS impairment in older outpatients with cancer using a combination of the information collected with the ADL and short IADL scales. Our second objective was to describe the potential impact of this combined FS on three-month unplanned hospitalizations and three-month mortality in this population. ResultsThe median age was 81 years and 61.2% were men. The most common types of tumours were lung and thoracic (22.3%). Concerning FS, 255 patients (41.6%) had unimpaired ADL-IADL, 131 patients (21.4%) had IADL impairment, 38 patients (6.2%) had ADL impairment, and 189 patients (30.8%) had impaired ADL-IADL. In the multivariate Cox analysis, metastatic stage (adjusted Hazard Ratio (aHR) = 1.79; 95% CI [1.14–2.80]) and impaired ADL-IADL (aHR = 3.46; 95% CI [1.89–6.33]) were independently associated with three-month mortality. In the logistic regression model, impaired ADL-IADL (adjusted Odd ratio (aOR) = 3.64; 95% CI [1.84–7.20]) was the only factor independently associated with three-month unplanned hospitalizations. InterpretationThe combined use of the ADL and IADL scales to evaluate functional status in older patients with cancer is of significant prognostic value regarding the risks of three-month unplanned hospitalizations and mortality.

S48DIFFERENTIAL CHRONOTYPE POLYGENIC LOAD IN PSYCHIATRIC DISORDERS

Psychological and social factors have been linked to stroke mortality; however, their impact on stroke disability is unclear. The purpose of this study was to evaluate the impact of pre-stroke fatalism, depressive symptoms, and social support on 90-day neurologic, functional, and cognitive outcomes.Ischemic strokes (2008-2011) were identified from the Brain Attack Surveillance in Corpus Christi Project. Validated scales were used to assess fatalism, depressive symptoms, and social support during baseline interviews. The National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living (ADL/IADL) scale, and Modified Mini-Mental State Exam (3MSE) were used to assess 90-day outcomes. The associations between the pre-stroke variables and 90-day outcomes were estimated from regression models adjusting for demographics, risk factors, tissue-type plasminogen activator treatment, and comorbidities.Among 364 stroke survivors, higher pre-stroke fatalism was associated with worse functional (.17 point higher ADL/IADL per interquartile range [IQR] higher fatalism; 95% confidence interval [CI]: .05, .30) and cognitive (2.81 point lower 3MSE per IQR higher fatalism; 95% CI: .95, 4.67) outcomes. Higher pre-stroke depressive symptoms were associated with worse functional (.16 point higher ADL/IADL per IQR higher Patient Health Questionnaire-9; 95% CI: .04, .28) and cognitive (2.28 point lower 3MSE per IQR higher Patient Health Questionnaire-9; 95% CI: .46, 4.10) outcomes. Participants in the middle tertile of social support had better cognitive outcomes (3.75 points higher 3MSE; 95% CI: .93, 6.56) compared with the highest tertile.The associations between pre-stroke fatalism, depressive symptoms, and social support and 90-day outcomes suggest that psychosocial factors play an important role in stroke recovery.

Short-Term Disability Fluctuations in Late Life.

Late-life disability is highly dynamic but within-person short-term fluctuations have not been assessed previously. We analyze how substantial such late-life disability fluctuations are and whether they are associated with time-to-death, long-term disability trajectories, frailty, and sociodemographics. Monthly survey data (Precipitating Events Project Study) on activities of daily living/instrumental activities of daily living (ADL/IADL) disability (0-9) in the last years of life from 642 deceased respondents providing 56,308 observations were analyzed with a two-step approach. Observation-level residuals extracted from a Poisson mixed regression model (first step), which depict vertical short-term fluctuations from individual long-term trajectories, were analyzed with a linear mixed regression model (second step). Short-term disability fluctuations amounted to about one ADL/IADL limitation, increased in the last 4 years of life, and were closely associated with disability increases. Associations with frailty or sociodemographics characteristics were absent except for living alone. Short-term disability fluctuations in late life were substantial, were linked to mortality-related processes, and represent a concomitant feature of disability increases in late life.

Evaluation of Activities of Daily Living/Instrumental Activities of Daily Living to Accurately Determine Severity of Moderate and Severe Alzheimer’s Disease: Comparison of Assessments by Receiver Operating Characteristic Curve and Discriminant Analyses

Aim: The aim of this study was to determine Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) evaluations that will enable better understanding of the severity of Alzheimer’s disease (AD). Methods: AD patients were evaluated by Functional Independence Measure (FIM), Hyogo Activities of Daily Living Scale (HADLS), and Assessment of Motor and Process Skills (AMPS) to identify the assessments that will enable highly precise discrimination of AD Clinical Dementia Rating (CDR) 2 (moderate) and CDR3 (severe) using receiver operating characteristic (ROC) curve and discriminant analyses. Results: The participants were 75 AD patients (CDR2 = 50, mean age = 80.3 ± 5.9 years; CDR3 = 25, mean age = 78.3 ± 9.0 years). The evaluation methods consisted of FIM, HADLS, and AMPS. The results were divided into FIM-M, FIM-C, HADLS-ADL, HADLS-IADL, AMPS-motor skills, and AMPS-process skills. The values for the area under the curve (AUC) were compared by ROC curve and discriminant analyses. AUC values for FIM-C and AMPS-process skills were 0.956 and 0.947, respectively. With these two evaluations only, values ≥0.9 were shown. Moreover, the AUC of the discrimination score (combination of the FIM-C and AMPS-process skills) was significantly higher than those for FIM-M, FIM-C, HADLS-ADL, HADLS-IADL, and AMPS-motor skills. Conclusions: The results demonstrated that evaluation by FIM-C and AMPS-process skills methods was useful for discriminating between CDR2 (moderate) and CDR3 (severe) AD. Moreover, the results indicated that these two evaluation methods enabled more accurate determination of severity and the spared capabilities of AD patients.

The clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry.

The authors describe the demographics and clinical characteristics of the first 517 patients enrolled in the Adult Hydrocephalus Clinical Research Network (AHCRN) during its first 2 years. Adults ≥ 18 years were nonconsecutively enrolled in a registry at 6 centers. Four categories of adult hydrocephalus were defined: transition (treated before age 18 years), unrecognized congenital (congenital pattern, not treated before age 18 years), acquired (secondary to known risk factors, treated or untreated), and suspected idiopathic normal pressure hydrocephalus (iNPH) (≥ age 65 years, not previously treated). Data include etiology, symptoms, examination findings, neuropsychology screening, comorbidities, treatment, complications, and outcomes. Standard evaluations were administered to all patients by trained examiners, including the Montreal Cognitive Assessment, the Symbol Digit Modalities Test, the Beck Depression Inventory-II, the Overactive Bladder Questionnaire Short Form symptom bother, the 10-Meter Walk Test, the Boon iNPH gait scale, the Lawton Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) questionnaire, the iNPH grading scale, and the modified Rankin Scale. Overall, 517 individuals were enrolled. Age ranged from 18.1 to 90.7 years, with patients in the transition group (32.7 ± 10.0 years) being the youngest and those in the suspected iNPH group (76.5 ± 5.2 years) being the oldest. The proportion of patients in each group was as follows: 16.6% transition, 26.5% unrecognized congenital, 18.2% acquired, and 38.7% suspected iNPH. Excluding the 86 patients in the transition group, who all had received treatment, 79.4% of adults in the remaining 3 groups had not been treated at the time of enrollment. Patients in the suspected iNPH group had the poorest performance in cognitive evaluations, and those in the unrecognized congenital group had the best performance. The same pattern was seen in the Lawton ADL/IADL scores. Gait velocity was lowest in patients in the suspected iNPH group. Categories that had the most comorbidities (suspected iNPH) or etiologies of hydrocephalus that directly cause neurological injury (transition, acquired) had greater degrees of impairment compared to unrecognized congenital, which had the fewest comorbidities or etiologies associated with neurological injury. The clinical spectrum of hydrocephalus in adults comprises more than iNPH or acquired hydrocephalus. Only 39% of patients had suspected iNPH, whereas 43% had childhood onset (i.e., those in the transition and unrecognized congenital groups). The severity of symptoms and impairment was worsened when the etiology of the hydrocephalus or complications of treatment caused additional neurological injury or when multiple comorbidities were present. However, more than half of patients in the transition, unrecognized congenital, and acquired hydrocephalus groups had minimal or no impairment. Excluding the transition group, nearly 80% of patients in the AHCRN registry were untreated at the time of enrollment. A future goal for the AHCRN is to determine whether patients with unrecognized congenital and acquired hydrocephalus need treatment and which patients in the suspected iNPH cohort actually have possible hydrocephalus and should undergo further diagnostic testing. Future prospective research is needed in the diagnosis, treatment, outcomes, quality of life, and macroeconomics of all categories of adult hydrocephalus.

Prevalence of Dementia Among Older Patients: A Hospital-Based Study in Iran.

Dementia constitutes a public health hazard in developing countries. The aim of this study was to evaluate the prevalence of dementia and its associated factors in older hospitalized patients. The participants of this cross-sectional study consisted of older patients admitted to medical wards in Rasoul-e Akram hospital in Tehran, Iran. Mini-Mental State Examination, Mini-Cog test, Geriatric Depression Scale, Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, and socioeconomic questionnaires were used. A total of 205 elderly inpatients were included. The mean age was 71.33 ± 7.35 years; 63.4% of the participants had normal cognitive function, while 36.6% had some degree of cognitive impairment. There was a statistically significant relationship between gender, age, number of children, and occupation and the prevalence of dementia. Appropriate cognitive screening of older patients upon admission to hospitals could help identify potential adverse events and enhance the quality of care for patients with comorbid dementia.

The Impact of Pre-Stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke

Psychological and social factors have been linked to stroke mortality; however, their impact on stroke disability is unclear. The purpose of this study was to evaluate the impact of pre-stroke fatalism, depressive symptoms, and social support on 90-day neurologic, functional, and cognitive outcomes. Ischemic strokes (2008-2011) were identified from the Brain Attack Surveillance in Corpus Christi Project. Validated scales were used to assess fatalism, depressive symptoms, and social support during baseline interviews. The National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living (ADL/IADL) scale, and Modified Mini-Mental State Exam (3MSE) were used to assess 90-day outcomes. The associations between the pre-stroke variables and 90-day outcomes were estimated from regression models adjusting for demographics, risk factors, tissue-type plasminogen activator treatment, and comorbidities. Among 364 stroke survivors, higher pre-stroke fatalism was associated with worse functional (.17 point higher ADL/IADL per interquartile range [IQR] higher fatalism; 95% confidence interval [CI]: .05, .30) and cognitive (2.81 point lower 3MSE per IQR higher fatalism; 95% CI: .95, 4.67) outcomes. Higher pre-stroke depressive symptoms were associated with worse functional (.16 point higher ADL/IADL per IQR higher Patient Health Questionnaire-9; 95% CI: .04, .28) and cognitive (2.28 point lower 3MSE per IQR higher Patient Health Questionnaire-9; 95% CI: .46, 4.10) outcomes. Participants in the middle tertile of social support had better cognitive outcomes (3.75 points higher 3MSE; 95% CI: .93, 6.56) compared with the highest tertile. The associations between pre-stroke fatalism, depressive symptoms, and social support and 90-day outcomes suggest that psychosocial factors play an important role in stroke recovery.

Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic?

IntroductionOrthostatic hypotension (OH) may frequently be asymptomatic in patients with Parkinson's disease (PD). However, the relationship between symptomatic/asymptomatic status and functional disability remains unclear. MethodsUsing orthostatic blood pressure (BP) measurements and the Orthostatic Hypotension Symptom Assessment (OHSA) questionnaire, 121 consecutive PD patients without history of chronic hypertension and not taking alpha-adrenergic antagonists for bladder disorders were classified according to (1) OH symptomatic status, based on presence/absence of orthostatic symptoms (symptomatic OH: OHSA item 1 ≥ 1), and (2) OH severity, based on the magnitude of BP fall on the lying-to-standing test: OH- (<20/10 mmHg); moderate OH+ (≥20/10 mmHg but < 30/15 mmHg); and severe OH+ (≥30/15 mmHg). The primary endpoints were the activities of daily living/instrumental activities of daily living (ADL/iADL) and the Ambulatory Capacity Measure (ACM). Secondary endpoints included PD quality of life (PDQ-8) and prevalence of falls. ResultsThe overall prevalence of OH+ was 30.6% (37/121 patients), with 62.2% symptomatic (23/37) and 37.8% asymptomatic (14/37). Symptomatic and asymptomatic OH + patients had similar impairments in ADL/iADL and ACM, significantly worse than OH- (p ≤ 0.035). There was a trend for worse ADL/iADL and ACM scores in severe OH + compared to moderate OH+, but both were worse than OH- (p ≤ 0.048). Symptomatic and asymptomatic OH + showed similar impairment in PDQ-8 and higher prevalence of falls compared to OH-. ConclusionsAsymptomatic OH+ was associated with similar impairments in ADL/iADL and ACM than symptomatic OH+. These findings support screening for OH in PD patients regardless of postural lightheadedness.

Caregiver burden and fatigue in caregivers of people with dementia: Measuring human herpesvirus (HHV)-6 and -7 DNA levels in saliva

PurposeWe examined chronic fatigue, which has not been investigated in detail, in family caregivers for people with dementia. Methods and materialsForty-four community-dwelling family caregivers (the caregiver group: CG) and 50 elderly control participants (the non-caregiver group: NCG) participated in this study. We measured salivary human herpesvirus (HHV)-6 and -7 DNA levels and the Chalder fatigue scale (CFS) to assess levels of fatigue; we also measured the Center for Epidemiologic Studies-Depression Scale, Physical Activity Scale for the Elderly, Zarit Caregiver Burden Interview, Mini-Mental State Examination, Assessment of Motor and Process Skills, and Dementia Behavior Disturbance Scale. ResultsFor CG, the salivary HHV-6 DNA levels and CFS scores were significantly higher than those in NCG. The salivary HHV-6 DNA levels in CG were significantly correlated with depressive symptoms, the cognitive function of the patients, and the activities of daily living/instrumental activities of daily living (ADL/IADL) abilities of the patients. The CFS scores in CG significantly correlated with caregiver burden, depression symptoms, leisure physical activity, the number of other family caregivers, and the hours spent for caregiving per week, as well as with behavior disturbances and ADL/IADL abilities. ConclusionsThe salivary HHV-6 DNA levels may be added as a new biomarker for caregiver exhaustion. We concluded that fatigue assessments should be performed by not only a questionnaire, such as the CFS, but also by a biomarker search, such as HHV-6, when estimating the caregiver burden for family caregivers of people with dementia.

Evaluation of tolerance of Temozolomide in different strategies for management of the older person with glioblastoma

Introduction: The diagnostic value of Comprehensive Geriatric Assessment(CGA) in oncology centres has not yet been established in India. Objectives: To assess whether CGA is feasible,reproducible and comparable in oncology patients in India. Methods: Biopsy proven cancer patients above 65 years,visiting our centres consenting for CGA, not Delirious or suffering from Encephalopathy were included in this analysis.The following components of CGA were assessed: Medical parameters, Nutritional Status, Depression, Neurocognitive functioning, Activities of Daily Living/Instrumental Activities of Daily Living and Quality of Life. A brief self-assembled battery of standardised & culture-fair tests: Mini-mental Status Examination(MMSE), Geriatric Depression Scale(GDS), OARS Activities of Daily Living/Instrumental Activities of Daily Living(ADL/IADL), WHOQuality of Life Scale BREF(WHO-QOL). A trained Psychologist conducted all CGAs with the help of primary oncologist, dietician and occupational therapist.As an exercise, to estimate the feasibility of CGA tools, 1 patient was selected for a detailed CGA(completion time 6 hours). Later, an abbreviated version was developed whereby administration time reduced to 20-30 minutes per CGA and conducted on OPD,IPD and Day Care settings Results: Total N = 46 patients, met our inclusion criteria. Male: Female ratio = 26:20; Age-wise distribution:N65:16,N70-11,N75= 5,N804,N85= 1; Solid Tumors: Lymphoma patients = 38:8. All patients had Performance status of 0,1 7 2(except 1)according to ECOG.18 out of 38 had more than or equal to 2 co-morbidities. Refer the following tables: Interestingly on ADL/IADL scale, Excellent ADL/IADL(n= 11) and Good ADL/IADL(n= 6) whereas mild-moderate impairment in ADL/ IADL(n= 17) and Severely impairment(n= 7), except 1 with complete impairment.On WHO-QOL BREF, on Physical Health Satisfied: Unsatisfied= 11:27; Psychological Health Satisfied:Unsatisfied= 32:6; Social Relationships Satisfied:Unsatisfied= 28:10; Environment Satisfied:Unsatisfied= 27:3 All patients with Severe impairment on any/all areas,had performance status of ≤2 according to oncologist’s review. Conclusion: CGA is a feasible, reproducible procedure involving a multidisciplinary approach. A trained Psychologist is needed as per international standards to administer & interpret psychometric tools used for CGAs.Approx.20% patients had severe impairment in either/ all of the areas, were deemed fit for chemotherapy by the Medical Oncologist.

Assessments of functional status, comorbidities, polypharmacy, nutritional status and sarcopenia in Turkish community-dwelling male elderly

Functionality, comorbidities, polypharmacy, nutritional status and sarcopenia affect the prognosis of elderly excessively. These parameters are influenced by the population, living settings and age. We aimed to study these parameters in Turkish community-dwelling male elderly. We studied 274 male elderly ≥60 years of age admitted to our Geriatrics outpatient clinics. Mean age was 74.4 ± 7.1 years; 47.4% of the subjects were ≥75 years, 24.1% were ≥80 years. Mean activities-of-daily-living (ADL) and instrumental ADL (IADL) scores were 9.4 and 11.1, respectively. Patients with at least one-dependence at ADL–IADL were 22.6%–47.2%, and more than half-dependence at ADL–IADL were 2.8%–17.9%, respectively. Mean number of comorbidities were 2.6. Most common diagnosis was hypertension with 65%; mean number of drugs were 4.5; 55.3% were using ≥4 chronic drugs. Prevalences of malnutrition were 3.7%–6.9%, malnutrition risk were 23.5%–26.7% by the Mini Nutritional Assessment Test - Long Form and Short Form, respectively. Calf circumference was measured <31 cm in 10.5%. Our findings suggest that Turkish community-dwelling male elderly may have greater prevalences of functional dependence, sarcopenia but lower rates of malnutrition and similar rates of polypharmacy compared with the western developing countries and developed countries. This study emphasized the geographical differences in and/or between the individual countries highlighting the need for studies both country- and world-wide.

The trajectory of physical functioning during breast cancer treatment of older women.

9129 Background: We sought to characterize the trajectory of physical functioning during the first 12 months following initial breast cancer diagnosis in older women with stage I-III breast cancer. Methods: Between April 2008 and March 2010 a cohort of women ≥65 years with incident stage I-III breast cancer, were enrolled into a prospective cohort study following primary surgery or prior to neoadjuvant chemotherapy. Participants completed a comprehensive geriatric assessment at study entry, six and 12 months. The primary end-points was mean change in the total Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) scores from baseline to six and 12 months, respectively. A decrease in ADL/IADL scores denoted functional decline. Results: Of sixty-one women enrolled, 48 completed baseline and 12th month CGA, four withdrew from the study, five were lost to follow-up and four have pending 12th month assessment as of 12/31/2010. This report includes the 48 evaluable women. The median age was 73 years, (inter-quartile range 68.5-80 years), 90% had stage I-II disease, 35% had node positive disease, 85% had hormone-receptor positive disease and 35% received adjuvant chemotherapy and/or trastuzumab. The mean change in ADL/IADL scores at six and 12 months was -0.58 [(sd=1.39), p= 0.008] and -0.85 [(sd=2.37), p= 0.02], respectively. The proportion of women who had a decrease, an increase or no change in ADL/IADL scores at six and 12 months from baseline were 24%, 5% and 71%, and 29%, 10% and 61%, respectively. Women with lower than high school education (46% vs. 14%, p=0.03), Karnofsky Performance Status scores ≤80% (67% vs. 17%, p=0.002), any IADL dependency (63% vs. 13%, p=0.0003), Timed-Up-and-Go Test time >14 seconds, (67% vs. 22%, p=0.05) and tumor size ≥ 2cm, (50% vs. 13%, p=0.01) at baseline were more likely to develop functional decline at 12 months. Conclusions: One out of every four older woman with breast cancer developed functional decline within six months of treatment increasing to almost one out of every three older woman by 12 months. Studies to identify biologic, molecular and clinical determinants of functional decline in older women with breast cancer in the adjuvant setting are warranted to inform remediation.

Utility of the vulnerable elders survey for predicting sixth-month functional decline among older patients with newly diagnosed breast cancer.

598 Background: Instruments specifically validated for predicting functional decline in geriatric-oncology are nonexistent. The Vulnerable Elders Survey (VES), an instrument predicting functional decline among community dwelling older adults, has never been validated in oncology patients. We sought to examine the ability of the VES to predict functional decline at 6 months among older women with newly diagnosed breast cancer undergoing treatment. Methods: Between April 2008 and September 2009 women ≥ 65 years with incident stage I-IV breast cancer, were enrolled into a prospective cohort study at an academic center. The primary end-point was functional decline at 6 months, (yes/no), defined as ≥ 1-point decrement in Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) scores or admission to a nursing home during the follow-up period. Multiple logistic regression and Receiver Operator Curve (ROC) analyses were used to examine the relation between VES scores at baseline and function...

A comparative analysis of Medicaid long‐term care policies and their effects on elderly dual enrollees

Individuals with dual enrollment in Medicare and Medicaid have become the focus of heightened US federal and state policy interest in recent years. These beneficiaries are among the most vulnerable and costly persons served by either program. This analysis uses a reduced-form econometric model and a unique survey of community-resident dual enrollees to take a critical step toward understanding the relationships and combinations of state long-term care (LTC) policies and their relative effectiveness in achieving their intended effects: increasing access to care, improving activities of daily living/instrumental activities of daily living (ADL/IADL) assistance, and reducing unmet needs. We then simulate the effects of alternative policies to determine the most effective combination.The combination of policies that was most effective in reducing the percentage of individuals receiving low levels of assistance was high spending in the community relative to nursing home and low community LTC spending per recipient; that is, spending more on community care and spreading it across more people. Overall, this analysis confirms that Medicaid LTC policy decisions by states, and the combinations of policies that are implemented, result in important variations in levels of assistance to elderly persons with disabilities.

Functional Capacity and Health-Related Quality of Life in Individuals Post Stroke

Background: In individuals post stroke, cardiovascular and functional capacity is frequently reduced independent of severity. The psychological consequences of this reduction have only been briefly investigated. This study investigated the relationship between functional capacity and health-related quality of life (HRQoL) in individuals post stroke. Method: Thirty subjects with a mild stroke were tested 60 ± 27 months (mean ± SD) post stroke. Functional capacity was quantified with the 6-minute walk test (6MWT) and perceived HRQoL was evaluated by using the Stroke Impact Scale (SIS) version 3.0 questionnaire. Results: The 6MWT distance walked was 353 ± 137 m, that is, 63% of the distance predicted for healthy adults. HRQoL was reduced with the lowest SIS scores in the domains of strength, hand function, and participation domains and the highest scores in the domains of mobility, communication, activities of daily living/instrumental activities of daily living (ADL/IADL), and memory. The SIS domains of hand function, strength, mobility, ADL/IADL, and participation were all positively correlated with 6MWT distance, with the strongest correlation for the latter four domains. Conclusion: Reductions in both functional capacity and HRQoL were documented. Functional capacity was positively correlated with six of the HRQoL domains and was strongest with the SIS domains most related to demands made on the individual throughout the day.

Limitations in activities of daily living and instrumental activities of daily living capacity in a representative sample: disentangling dementia- and mobility-related effects

A representative sample of the Leipzig population aged 75 years and older showed 61.8% of the participants with relevant deficits in their capacity for independent living, according to a combined activities of daily living/instrumental activities of daily living (ADL/IADL) scale. The quantity and quality of care needed almost exponentially increases above 85 years of age. Looking at potential reasons for ADL/IADL limitations, 44% of variance in single ADL/IADL activities and 75% of the combined ADL/IADL sum score could come from a minimal set of predictor variables. Most important are dementia- or mobility-related declines, but living conditions also explain small but significant amounts of variance. These seem initially impressive, yet analyses showed about half the explained variances shared among the mobility and dementia indicators, limiting the use not only of ADL/IADL sum scores but of many single ADL/IADL items as well. Before deriving specific conclusions from variations in ADL/IADL instruments, one must note that the data suggest that interpretations of covariations—whether for health/mobility or dementia—are useful and substantial only if both indicators/predictors are verified. The information given captures the mobility- and dementia-related variance if ADL/IADL items, facilitating more specific scale developments.